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Illinois rates for HCPCS B4154

Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.07 / $1.07 / $1.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $3.16
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.87 / $1.29 / $87.10
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.10 / $2.34 / $8.71
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.65 / $0.79 / $0.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.82 / $1.82 / $1.82
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $1.51 / $8.51
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.05 / $1.05 / $1.05
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.65 / $0.65 / $0.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.51 / $1.26 / $2.19